Taking Preds & Aspirin together.

[JOHNONE28]

At the moment I am taking 5mg of Preds. Due to a Branch Retinal vein occlusion my G P has recently prescribed me with 75mg of aspirin,stating that I should be sure to take my omeprazole to prevent tummy problems, Should I be worried, also what is the correct dose of the omeprazole & when should it be taken

[polkadotcom]

I am prescribed Lanzoprazole - similar to Omeprazole - and my instructions are to take it first thing in the morning half an hour before eating. As to the dose, that is probably individual and the instructions should be provided by your surgery.

I have been taking 75mg aspirin for years now alongside Pred and haven't had the slightest problem with them. I was given the aspirin when I was diagnosed with GCA.

[PMRpro Ambassador]

The guidelines from the British Society of Rhematologists suggests that patients who have been diagnosed with GCA should be given a low dose of aspirin daily alongside their pred - so I don't think you need to worry too much since GCA patients are on much higher doses of pred. You shouldn't use aspirin and pred together otherwise but in this case the benefits outweigh the risks. The problem is that both pred and aspirin each increase the risk of bleeding from the stomach wall, taking both together in larger doses increases the risk a lot.

The dose of omeprazole you are to take will be on the pack dispensed by the pharmacist. If it isn't check with the pharmacist (not the counter staff at the chemist). There is a range of dosages so I can't tell you what is right for you - if the starting dose isn't enough to prevent symptoms someone with gastric problems would be told to take more. If you are being given it for protection it may be different.

[mickt]

Had a episode with left eye ,like a grey cloud only lasted 5 secs than lifted ,im reducing 15 -10 pred alternative days ,will speak to consultant Tuesday.It was when I stood up after sitting for half hr,been to baths swam 10 length felt better til bloody eye,it hasn't happened for a hr tho.Which is good.

[Asbeck in reply to mickt]

mickt: Do you have GCA? I have "flashes" that are somewhat like migraine headache flashes without the headache. Probably no problem. However, my eye doctor asked how long they lasted. Mine last 20 min. which is a factor in deciding that they have nothing to do with the retina. He said that the eye stuff with GCA is for just a few seconds. Your problem was for just a few seconds--5 sec. If you search here for blind or blindness there are people on here who have described what happened before they went blind. A grey cloud doesn't sound good to me. Black spots aren't good either. And an interruption of sight (seeing black) is very, very bad. Good luck. Maybe if it happens again you should not wait until Tues.

[Whittlesey in reply to mickt]

Hi Mickt, If you have GCA, that sounds like the curtain of darkness, some of us get. I had it a couple of times in the beginning, before the huge doses of prednisone. I was told to get to the ER immediately if I had that, no better how "fine" I felt otherwise. It may well be an indicator of sight loss coming as Asbeck has suggested. My doctors said this is a very serious effect of GCA and get to a hospital ASAP and tell them you are having a "flare" and have had the "curtain of darkness". (like a curtain being pulled over your eye) Any specialist or doctor experienced in GCA will know what you are talking about. Treatment is usually a high dose of steroids for a few days, but this prevents blindness. Would not "up" your prednisone, on your own. Might not work enough. And you don't have the equipment to monitor your eyes. My eye discs were swollen, the second time I went in, which is serious. Wouldn't even call for advice, would just go to the ER. Blindness can happen in less than a day with GCA and can be irreversible. It can get bad after that. There is no need for this to happen. Would go to the Emergency Room. All my best, Whittlesey, U.S.

[mickt in reply to Whittlesey]

I have been to rvi Newcastle eyecentre had thorough examination of eyes and all ok.They have upped my steroid was 15-10 back up to 20 -15.Ill see what my rheumatologist says when he gets back .Also ive to tell opthamologist secretary tomorrow.Only had one short episode today ive taken 20 mg pred since hosp so had 30 today ,20mgs methotrexate.Will start 20 -15 mg pred alternative days tomorrow.Thanks for your replies.

[Whittlesey in reply to mickt]

Mickt, I understand what you are saying. I also had my eyes examined, several times before I got the diagnosis of GCA. And they were "ok". The damage from GCA often doesn't show up in a "traditional" eye exam. They need to look at the temporal arteries, also.

With GCA or temporal arteritis, the temporal arteries become inflamed. Sometimes the blood can't pass through to the eye nerve. The temp. arteries supply the eye nerve. If the blood doesn't go through -- the eye goes blind. The nerve, usually red, goes white and the eye "doesn't work". And many times the treatment doesn't bring the sight back.

If you do have GCA and the "curtain" is a strong indicator, there is often no warning, other than that -- the curtain.

If you have a high c reactive protein and high sed rate (my sed rate was normal, but CRP -- high) -- and sometimes the artery swells out on both or either side of your temple, these are very strong indicators of GCA. They can do a biopsy and often it shows the enlarged cells which cause the inflammation. Sometimes the biopsy doesn't show this, but you might have GCA (wrong place in the artery or a course of steroids, which has gotten the inflammation down and it doesn't show). But if you have it, it needs to be treated as what it is. It is a little different than PMR.

They treat you with a high dose of steroid, in the beginning, 100 mgs or 80 mgs. When it seems there is response, they begin to lower it. I am at 3 mgs per day. The first day it was 100 mgs, then later, 80, then 60mgs. I then had a flare and they were giving me 120mgs of methytextrate every six hours. I got pretty sick from the prednisone and finally told them, only one injection a day. My eyes were then ok and I was released.

I have some vision loss in my left eye and peripheral vision isn't good in my left eye.

Sometimes the lower doses of prednisone aren't enough to deal with GCA. I believe any emergency room would take you and treat you, if you explained about this greyness in sight. If you say it is a "curtain" of darkness, they should take you, because that is a classic symptom of GCA. GCA is pretty serious, wouldn't take chances. of course, it's your decision.

Hope it works out and wish you the best.

all my best, Whittlesey

[JOHNONE28]

I haven't had any tummy problems whilst taking preds, I was worried that the two combined may present problems.

The eye problem has not presented any symptoms but was found during an eye test & confirmed with a scan by the eye clinic who then suggested the aspirin.I have been taking both drugs now for about a month with 20mg of

omeprazole up to now no symptoms of tummy problems.

[optimist-ok]

I have been taking preds & aspirin for the last 2.5 yrs, due to PMR/GCA. I also take omeprazole twice a day, with breakfast & before evening meal. So far OK! Down to 4mg this week after doing alternate days of 5 then 4mg for a month. Hope this helps.

[tomasina]

I have taken Omeprazole, Prednisolone and Aspirin 75mgs. for three and a half years since my diagnosis of GCA/PMR. No problems with them.

Good luck.

Tomasina x

[Whittlesey]

Hi Johnone28, I have diagnosed GCA, since 2012. I have been prescribed 81mg of aspirin per day. I am currently taking 3mgs of medrol a day. Originally I started with 60 mgs of prednisone per day and the aspirin was prescribed then. I have been taking it since then and sometimes take a nexium. From what I've read and spoken to rheumatologists about, aspirin can be both a steroid sparing agent, and it, itself, can help, reduce the type of inflammation we are dealing with. Methetextrate also, in some people can be a steroid sparer. But aspirin works in this capacity. I think studies were done, to try and use aspirin and methetextrate after the first initial large doses of prednisones to avoid some of the serious side effects of prednisone. In those studies, I don't think there was a specific finding on if aspirin can be fully used in this way.

I also have pseudo aneuryisms and aspirin helps with these and hopefully to offset a stroke.

With what we have, it seems to be helpful with most people. As in so many aspects of this, everyone reacts differently and it may not help everyone.

Hope you feel better. wishing you health, all my Whittlesey

[PMRpro Ambassador in reply to Whittlesey]

I think you may have misunderstood a statement. Aspirin is not a steroid sparing agent - and anyway its side effects when used consistently and at high doses are probably as bad as pred! The aspirin used in GCA is as a platelet inhibitor to prevent clots forming that could cause stroke or heart attack which are more common in patients with GCA (and other vasculitides). Studies have been done to see if there is a better long term outcome if aspirin is used alongside pred - and the cardiovascular events are reduced. Most steroid sparers change the way the body processes pred so a lower dose achieves the same result and aspirin doesn't do this although it does have some effect because of the antiinflammatory action but the dose used in GCA is so low this isn't particularly relevant.

[Whittlesey in reply to PMRpro]

Yes, it was explained to me , I believe that it is a platelet inhibitor. And it does help somewhat in reduction of inflammation. I understand that it isn't enough of an inflammation reducer, as a complete treatment for GCA. It was prescribed, to take everyday, when the arterial dissections and pseudoaneuyrisms were found. And in 5 months, the aneuyrisms have not changed positions or moved upwards, which is good.

[Whittlesey]

Ho Johnone28, I am currently taking 4mgs of pred a day and an aspirin 83mgs a day. If I take it with food, I usually don't have to take anything for my stomach. Sometimes I can feel the burning and I take nexium. I have been prescribed omeprazole and for some reason it makes the stomach burning worse, I don't know why. The nexium works, so I take that. But I don't have to take it all the time. Also you can get the enteric aspirin which is coated. When I use that, it doesn't bother my atomach. Taking the aspirin as an anti stroke preventative. good luck with this and with the running ! all my best, Whittlesey